Article
A Unique Retractable Guide Block Used in Volar Locking Plate Fixation for Distal Radius Fracture
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Authors
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Chieko Kadoma
- Itabashi Chuo Medical Center, Tokyo, Japan
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Isao Sasaki
- Clark Hospital, Sapporo, Japan
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Volar locking plate fixation is one of the most common surgical treatments in distal radius fracture. Careful attention during placing the plate and fixating the fracture needs to be payed not to injure soft tissues, especially median nerve, radial artery and flexor pollicis longus (FPL) tendon. To make sure the soft tissues are protected, we use a unique retractable guide block (RGB). The aim of this study is to introduce this guide block and the clinical results.
Methods: The retractable guide block has each screw and Kirschner - wire holes, covers the whole plate except distal ulnar screw hole, and has enough height to retract from the bone level to the skin level. The subjects were 84 wrists of 84 cases that underwent volar locking plate fixation for distal radius fracture with a retractable guide block. 24 were male and 60 were female, the mean age was 69 years old (range 19 - 91), 42 were right hands and 42 were left hands. According AO classification, type A2 were 17, type A3 were 21, type B3 were six, type C1 were eight, type C2 were 26, and type C3 were six. The median observation periods were 364.5 day (187.5 - 407 day), the mean operation time was 65.4 minutes (SD 20.8), and the median loss of correction on X-ray was 0 degree (range 0 - 13). The number of surgeons of clinical fellow year were 10 in first year, 14 in second year, 16 in third year, 12 in fourth year, and 32 in fifth year and older. Each year of surgeon treated any AO type fracture with no difference statistically. We retrospectively examined the difference of operation time, the loss of correction on X-ray, and complication according to AO classification.
Results: Neither operation time or loss of correction was statistically different among AO classification. One complication was observed, which was one screw protrusion into articular surface during the time course.
Conclusion: Owing to the shape of RGB, the risk of injuring soft tissues such as median nerve and FPL tendon is very low. In addition, the data of the operation time and the loss of correction indicated the probability of stable performance regardless of AO classification. We introduced a unique retractable guide block that has potential for safety and stability in surgical performance.
